INTRAVENOUS TISSUE PLASMINOGEN-ACTIVATOR FOR THE TREATMENT OF ACUTE THROMBOEMBOLIC ISCHEMIA

Eighteen patients were treated with 70 mg tissue plasminogen activator (t-PA) intravenously after the onset of acute severe cerebral ischemia: 10 suffered from vertebrobasilar occlusive disease and 8 had carotid territory strokes. In the former, reperfusion rates were poor (4/10) which was associated with a fatal clinical outcome in 7. In patients with internal carotid and middle cerebral artery occlusions, reperfusion rates were similarly low (3/7), 3 patients died from ischemia independent from the observed perfusional state and 1 suffered a fatal hemorrhage after infusion of less than 25 mg t-PA. Since many of the patients particularly with vertebrobasilar disease were somnolent or stuporous, an unfavorable delay between thrombosis and thrombolysis was suggested - in addition, since infarction was obvious on CT. In all, the dosage selected seemed to be too low to be efficient. Further investigations are required to test the benefit of earlier treatment (< 4 h) with higher dosages of t-PA.